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ACP: Noninvasive treatments for acute, subacute, and chronic low back pain

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The American College of Physicians (ACP) has developed a clinical practice guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain, one of the most common reasons for physician visits in the United States.

The American College of Physicians (ACP) has developed a clinical practice guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain, one of the most common reasons for physician visits in the United States. In its first recommendation, ACP said that, given that most individuals with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should opt for nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation. If pharmacologic treatment is desired, ACP suggested NSAIDs or skeletal muscle relaxants. In its second recommendation, ACP said that patients with chronic low back pain should initially try nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation. For the third recommendation, ACP said that patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy should consider pharmacologic treatment with NSAIDs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option for individuals who have failed the aforementioned therapies and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.

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http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

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